Family medicine physicians' perception and attitudes of herbal substances use in greater Lisbon region

Abstract

Background: Previous works showed patients preference for herbal substances (HS) although they also highlighted a discrepancy with physicians' adherence to HS and its recommendation.

Hypothesis/purpose: This study aimed to assess physician's perception and attitudes concerning the use of HS for their patients in a Family Medicine approach.

Study design: Observational cross-sectional exploratory study.

Methods: A questionnaire survey was applied to National Health System physicians; 113 questionnaires were distributed in the Greater Lisbon region.

Results: 80 valid questionnaires were received. The age of participants ranges from 29 to 64 with mean age of M ± SD:51.9 ± 10.0 years, mostly women (71.4%). Of these, 61.5% were unaware of traditional herbal medicinal products' (THMP) legal recognition and 67.3% of the difference between THMP and well-established use medicines. Absence of accordance between use and knowledge of herbal medicines (HM)/herbal products (HP) (p = 0.025) can be related to lack of Phytotherapy knowledge perception based on the nonexistence of specific training reported by 94.0% of physicians. Through factor analysis, three dimensions were obtained: Factor1, ``Use''; Factor2, ``Autonomy''; Factor3 ``Effort''. The overall Cronbach's α was 0.77, and 0.82 for Factor1. The evidence of use/prescription, has a correlation with ``Use'' (p < 0.0001), willingness to prescribe (p < 0.0001) and self-medication (p < 0.0001). There is a correlation (r = 0.605, p < 0.0001) between HS recommendation and self-medication. There were differences in use, perception and attitudes among Personalized-Health-Care Units and Family-Health Units physicians in relation to Factor1: p = 0.007 and Factor2: p = 0.021, age (p = 0.001), years of Medical career (p = 0.002), HM use (p = 0.014) and information about alternatives (p = 0.03). Physicians who answered correctly to the question on silymarin had higher scores in factor1 than those who did not: 1.76 vs. 1.25 (p = 0.019).

Conclusion: Low adherence to HS and little use of HM/HP were confirmed, highlighting the need for specific knowledge in Phytotherapy and its regulatory framework. This knowledge will enable the evaluation of herb-drug interactions and HM/HP adverse effects by the physicians thus justifying the integration of programmatic contents about HS in Medical Education.

Keywords: Family medicine; Medical education; Phytomedicine; Phytotherapy; Traditional herbal medicines.